Depression

What is Depression?

Major depressive disorder, or major depression, is characterized by a combination of symptoms that interfere with a person’s ability to work, sleep, study, eat, and enjoy once-pleasurable activities (www.nimh.nih.gov, 2014).

Episodes of depression often follow stressful events such as marital problems or the death of a loved one. The exact causes of depression still are not clear. What we do know is that both genetics and a stressful environment, or life situation, contribute to its cause or sudden onset.

Signs and Symptoms

If you have been experiencing some of the following signs and symptoms most of the day, nearly every day, for at least two weeks, you may be suffering from depression:

Persistent sad, anxious, or “empty” mood

Feelings of hopelessness, or pessimism

Irritability

Feelings of guilt, worthlessness, or helplessness

Loss of interest or pleasure in hobbies and activities

Decreased energy or fatigue

Moving or talking more slowly

Feeling restless or having trouble sitting still

Difficulty concentrating, remembering, or making decisions

Difficulty sleeping, early-morning awakening, or oversleeping

Appetite and/or weight changes

Thoughts of death or suicide, or suicide attempts

Aches or pains, headaches, cramps, or digestive problems without a clear physical cause and/or that do not ease even with treatment

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms while others may experience many. Several persistent symptoms in addition to low mood are required for a diagnosis of major depression, but people with only a few – but distressing – symptoms may benefit from treatment of their “subsyndromal” depression. The severity and frequency of symptoms and how long they last will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Different Kinds of Depression

There are many names for the different types of depression. Depression often co-exists with other mental or physical illnesses. Substance abuse, anxiety disorders, and eating disorders are particularly common conditions that may be worsened by depression, and it is important that the depression and each co-occurring illness be appropriately diagnosed and treated. Substance use disorders (abuse or dependence) also frequently co-occur with depression.

Factors That Play a Role in Depression

Many factors may play a role in depression, including genetics, brain biology and chemistry, and life events such as trauma, loss of a loved one, a difficult relationship, an early childhood experience, or any stressful situation.

Depression can happen at any age, but often begins in the teens or early 20s or 30s. Most chronic mood and anxiety disorders in adults begin as high levels of anxiety in children. In fact, high levels of anxiety as a child could mean a higher risk of depression as an adult.

Depression can co-occur with other serious medical illnesses such as diabetes, cancer, heart disease, and Parkinson’s disease. Depression can make these conditions worse and vice versa. Sometimes medications taken for these illnesses may cause side effects that contribute to depression. A doctor experienced in treating these complicated illnesses can help work out the best treatment strategy.

Research on depression is ongoing, and one day these discoveries may lead to better diagnosis and treatment. To learn more about current research, visit the NIMH website at www.nimh.nih.gov.

Types of Depression

There are several types of depressive disorders.

Major depression: Severe symptoms that interfere with the ability to work, sleep, study, eat, and enjoy life. An episode can occur only once in a person’s lifetime, but more often, a person has several episodes.

Persistent depressive disorder: A depressed mood that lasts for at least 2 years. A person diagnosed with persistent depressive disorder may have episodes of major depression along with periods of less severe symptoms, but symptoms must last for 2 years.

Some forms of depression are slightly different, or they may develop under unique circumstances. They include:

Psychotic depression, which occurs when a person has severe depression plus some form of psychosis, such as having disturbing false beliefs or a break with reality (delusions), or hearing or seeing upsetting things that others cannot hear or see (hallucinations).

Postpartum depression, which is much more serious than the “baby blues” that many women experience after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.

Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.

Bipolar disorder is different from depression. The reason it is included in this list is because someone with bipolar disorder experiences episodes of extreme low moods (depression). But a person with bipolar disorder also experiences extreme high moods (called “mania”).

You can learn more about many of these disorders on the NIMH website at www.nimh.nih.gov.

Depression affects people in different ways.

Not everyone who is depressed experiences every symptom. Some people experience only a few symptoms. Some people have many. The severity and frequency of symptoms, and how long they last, will vary depending on the individual and his or her particular illness. Symptoms may also vary depending on the stage of the illness.

Women

My friends keep asking what’s wrong with me. I have a great job and a wonderful family. But nothing seems fun anymore. I’m tired all the time. I’m trying to force myself to be interested in my kid’s activities, but I’m just not anymore. I feel lonely, sad, and don’t have the energy to get things done. I feel like I’m being a bad mom.

Women with depression do not all experience the same symptoms. However, women with depression typically have symptoms of sadness, worthlessness, and guilt.

Depression is more common among women than among men. Biological, lifecycle, hormonal, and psychosocial factors that are unique to women may be linked to their higher depression rate. For example, women are especially vulnerable to developing postpartum depression after giving birth, when hormonal and physical changes and the new responsibility of caring for a newborn can be overwhelming.

Men

I’d drink and I’d drink just to get numb. I’d get numb to try to numb my head. You’re talking many, many beers to get to that state when you can shut your head off. But then you wake up the next day, and it’s still there. You have to deal with it. It doesn’t just go away.

Men often experience depression differently than women. While women with depression are more likely to have feelings of sadness, worthlessness, and excessive guilt, men are more likely to be very tired, irritable, lose interest in once-pleasurable activities, and have difficulty sleeping.

Men may turn to alcohol or drugs when they are depressed. They also may become frustrated, discouraged, irritable, angry, and sometimes abusive. Some men may throw themselves into their work to avoid talking about their depression with family or friends, or behave recklessly. And although more women attempt suicide, many more men die by suicide in the United States.

Children / Adolescents

Depression may have a slightly different set of symptoms when a child or teen has it. Children and adolescents may be more likely to have symptoms like unexplained aches and pains, irritability and social withdrawal. On the other hand, symptoms more likely to affect adults include slowed speech and activity, sleeping too much and believing things that aren’t true (delusions).

Older Adults

Depression is not a normal part of growing older. Older adults may be going through changes such as children moving away, illness, moving to assisted living facilities or the death of loved ones. All of these things can cause feelings of sadness or grief. But when feelings of sadness last for a significant length of time and keep older adults from enjoying life the way they used to, it may be a sign that they should seek treatment.

Taking the First Step toward Wellness

The symptoms of mental disorders can have a profound effect on someone’s quality of life and ability to function. Treatment can address symptoms as well as assist someone experiencing severe or ongoing stress. Some of the reasons that you might consider seeking out psychotherapy include:

Overwhelming sadness or helplessness that doesn’t go away

Serious, unusual insomnia or sleeping too much

Difficulty focusing on work or carrying out other everyday activities

Constant worry and anxiety

Drinking to excess or any behavior that harms self or others

Dealing with a difficult transition, such as a divorce, children leaving home, job difficulties, or the death of someone close

Children’s behavior problems that interfere with school, family, or peers

Seeking help is not an admission of weakness, but a step towards understanding and obtaining relief from distressing symptoms.

Listed below are either evidence-based practices or promising practices that have been successful at treating Depressive Disorders.

Pharmacological Treatments (Medications)

Pharmacological treatments are medical based interventions administered to reduce the symptoms of the individual.Antidepressants are medicines that treat depression. They may help improve the way your brain uses certain chemicals that control mood or stress. You may need to try several different antidepressant medicines before finding the one that improves your symptoms and has manageable side effects. A medication that has helped you or a close family member in the past will often be considered.

Antidepressants take time – usually 2 to 4 weeks – to work, and often, symptoms such as sleep, appetite, and concentration problems improve before mood lifts, so it is important to give medication a chance before reaching a conclusion about its effectiveness. If you begin taking antidepressants, do not stop taking them without the help of a doctor. Sometimes people taking antidepressants feel better and then stop taking the medication on their own, and the depression returns. When you and your doctor have decided it is time to stop the medication, usually after a course of 6 to 12 months, the doctor will help you slowly and safely decrease your dose. Stopping them abruptly can cause withdrawal symptoms.

Please Note: In some cases, children, teenagers, and young adults under 25 may experience an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed. This warning from the U.S. Food and Drug Administration (FDA) also says that patients of all ages taking antidepressants should be watched closely, especially during the first few weeks of treatment. If you are considering taking an antidepressant and you are pregnant, planning to become pregnant, or breastfeeding, talk to your doctor about any increased health risks to you or your unborn or nursing child.

To find the latest information about antidepressants, talk to your doctor and visit www.fda.gov .

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